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U.S. Lawmakers Lobby To Allow Self-Referral

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A U.S. House subcommittee is urging—or, depending on how you look at it, pressuring—the Medicare Payment Advisory Commission (MedPAC) to stop trying to limit reimbursements for self-referred imaging.

The three separate laws that are collectively known as the Stark Law restrict physicians from referring patients for services in which the referring physicians have a financial interest. Radiologists in general, and the American College of Radiology in particular, have grumbled about exceptions that allow self-referral for in-office imaging facilities. The exceptions, they say, have led to overutilization of advanced imaging, which is expensive and often involves a hefty dose of radiation.

MedPAC, a congressional agency, has been considering proposals that would tighten some of the exceptions and thus cut back on self-referral.

Lots of money is involved here, so it’s not surprising that attempts to limit self-referral would face fierce opposition. The subcommittee action, which was bipartisan, indicates the strength of that push-back.

Representatives Joseph R. Pitts, R-Pennsylvania, and Frank Pallone, D-New Jersey, sent a letter on May 20 to MedPAC Chairman Glenn M. Hackbarth, JD. Pitts and Pallone are the chairman and ranking minority member, respectively, of the House Energy and Commerce Committee’s Subcommittee on Health.

According to HealthImaging.com, the letter “insisted that MedPAC reconsider its vote to reduce payment levels and packaging for imaging.”

Use of advanced imaging, and associated costs, increased dramatically from 2000 through 2005. However, the letter said, the passage of the Deficit Reduction Act of 2005 and the imposition of additional Medicare reimbursement reductions began limiting that increase. “Since that time,” the letter said, “growth has been dramatically reduced.”

The letter cited Government Accountability Office statistics indicating that the growth in imaging was only 2.9 percent in 2008 and 2.1 percent in 2009. The letter also noted that additional reductions to payment levels for imaging services are already scheduled to kick in.

The letter said that accreditation requirements for advanced-imaging providers contained in the Medicare Improvements for Patients and Providers Act of 2008 as well as Medicare’s demonstrations-of-appropriateness criteria would further limit spending on imaging.

Of course, a lot of powerful interests have absolutely no interest in limiting either spending on imaging or self-referrals. Stay tuned. And follow the money.

Related seminars: National Diagnostic Imaging Symposium


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